Urban environment and gestational diabetes: insights and recommendations

The article by Shupler et al.1Shupler M. Klompmaker J.O. Leung M. et al.Association between density of food retailers and fitness centers and gestational diabetes mellitus in Eastern Massachusetts, USA: population-based study.Lancet Reg Health Am. 2024; 35100775https://doi.org/10.1016/j.lana.2024.100775Summary Full Text Full Text PDF Scopus (1) Google Scholar provides valuable insights into assessing the impact of the density of various food retailers and fitness centers on the incidence of gestational diabetes mellitus (GDM). As physicians, we are pleased to see the authors' focus on the environmental influences surrounding pregnant women. We commend the study's contributions and highlight key points for further exploration. First, while the study adjusts for race and education, it may overlook the effects of cultural background and personal dietary preferences on food choices and gestational diabetes risk. Additionally, other health behaviors like smoking,2Terry P.D. Weiderpass E. Ostenson C.G. Cnattingius S. Cigarette smoking and the risk of gestational and pregestational diabetes in two consecutive pregnancies.Diabetes Care. 2003; 26: 2994-2998https://doi.org/10.2337/diacare.26.11.2994Crossref PubMed Scopus (37) Google Scholar drinking,3Hinkle S.N. Bao W. Wu J. et al.Association of habitual alcohol consumption with long-term risk of type 2 diabetes among women with a history of gestational diabetes.JAMA Netw Open. 2021; 4e2124669https://doi.org/10.1001/jamanetworkopen.2021.24669Crossref Scopus (3) Google Scholar and sleep patterns4Rawal S. Hinkle S.N. Zhu Y. Albert P.S. Zhang C. A longitudinal study of sleep duration in pregnancy and subsequent risk of gestational diabetes: findings from a prospective, multiracial cohort.Am J Obstet Gynecol. 2017; 216: 399.e1-.e8https://doi.org/10.1016/j.ajog.2016.11.1051Summary Full Text Full Text PDF Scopus (53) Google Scholar could strengthen the findings' robustness even more. Second, while the study explores the relationship between the food environment and health outcomes, it may not delve deeply into the interplay and interactive effects between different environmental factors, such as how the coexistence of supermarkets and fast food outlets jointly influences dietary habits. This consideration could reveal more complex dynamics that affect eating behaviors within different neighborhoods. Third, the study overlooks seasonal changes and regional specifics like urban versus suburban differences, which could impact the availability of food outlets and fitness centers, affecting pregnant women's health.5Sallis J.F. Floyd M.F. Rodríguez D.A. Saelens B.E. Role of built environments in physical activity, obesity, and cardiovascular disease.Circulation. 2012; 125: 729-737https://doi.org/10.1161/CIRCULATIONAHA.110.969022Crossref PubMed Scopus (907) Google Scholar The study highlights the crucial role of urban planning in health outcomes, emphasizing the need to enhance food environments and physical activity spaces. As physicians, we should guide pregnant women to limit fast food intake, promote access to healthy food, offer nutritional guidance, and work with local authorities to craft supportive public policies. Xinyue Yang: Methodology, Writing–Original Draft; Zhiqiang Zhang: Conceptualization, Methodology, Supervision, Writing–Original Draft, Writing–Review & Editing. The authors have no conflict of interest. None. Funding: We received no funding for this study. Association between density of food retailers and fitness centers and gestational diabetes mellitus in Eastern Massachusetts, USA: population-based studyIn Eastern Massachusetts, living near a greater density of fast-food establishments was associated with higher GDM odds. Greater residential access to supermarkets and fitness centers was associated with lower the odds of having GDM. Full-Text PDF Open Access